Supportive Care in Cancer

, Volume 24, Issue 6, pp 2437–2444 | Cite as

Satisfaction with cancer care among American Indian and Alaska Natives in Oregon and Washington State: a qualitative study of survivor and caregiver perspectives

  • Sarah HohlEmail author
  • Yamile Molina
  • Lisel Koepl
  • Kerri Lopez
  • Eric Vinson
  • Hannah Linden
  • Scott Ramsey
Original Article



To better understand satisfaction with care among American Indian and Alaska Native (AI/AN) persons with cancer, we explored dimensions of the provider relationship that contributed to satisfaction among caregivers and survivors who received cancer treatment in Oregon and Washington State.


Between November 2011 and April 2013, the project team interviewed 11 caregivers and 71 AI/AN cancer survivors residing in Oregon and Washington State. Interview questions aimed to elicit participant experiences with care providers and factors associated with cancer care satisfaction. Interviews were analyzed using an inductive content analysis approach in which concepts were identified and themes derived from interview data.


Three overarching themes, each with two sub-themes, emerged from the data: (1) universal factors: bolstering understanding, involvement, and empathy in care; (2) minority-specific factors: incorporating culture and community into care; and (3) AI/AN-unique factors: interacting with Indian health clinics and Indian Health Service (IHS).


The results of our study suggest that satisfaction with care among survivors and their caregivers must be examined within the context of culture and community, particularly among minority patients. Our study demonstrates providers’ critical role in ensuring AI/AN patients emerge satisfied with cancer treatment by honoring their AI/AN-specific needs, such as respect for integration of traditional healing modalities and navigation of specialty care coordination.


Race/ethnicity Satisfaction with care Cancer health disparities Patient-provider relationship Cultural competence Survivorship 



American Indian/Alaska Native


Cancer among American Indians: A Multi-State Study


Fred Hutchinson Cancer Research Center


Hutchinson Center for Cancer Outcomes Research


Indian Health Service


non-Hispanic whites


Northwest Portland Area Indian Health Board



The authors would like to thank the staff and investigators at all collaborating institutions: the FHCRC Hutchinson Institute for Cancer Outcomes Research (HICOR); the Northwest Portland Area Indian Health Board; and the AIMS Advisory Board, Oregon State Cancer Registry. We would also like to extend our gratitude to the study participants and community members, who provided insight and perspective, and without whom this work would not be possible.

Compliance with ethical standards


The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NCI, FHCRC, HICOR, NPAIHB, University of Illinois-Chicago, Seattle Cancer Care Alliance, or the University of Washington. The authors have full access to all primary data. Given the ethical standards and protocols with this vulnerable population, primary data may be shared upon approval by the Portland Area Indian Health Service Institutional Review Board and the Northwest Portland Area Indian Health Board.


This work was supported by grants from the National Institutes of Health (NIH), National Cancer Institute (NCI) (R01 CA125231 to S. Ramsey).

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Sarah Hohl
    • 1
    • 2
    Email author
  • Yamile Molina
    • 3
  • Lisel Koepl
    • 1
  • Kerri Lopez
    • 4
  • Eric Vinson
    • 4
  • Hannah Linden
    • 1
    • 5
    • 6
  • Scott Ramsey
    • 1
    • 6
  1. 1.Fred Hutchinson Cancer Research Center, Public Health Sciences DivisionSeattleUSA
  2. 2.School of Public Health, Department of Health ServicesUniversity of WashingtonSeattleUSA
  3. 3.School of Public Health, Center for Research on Women and Gender, Cancer CenterUniversity of Illinois-ChicagoChicagoUSA
  4. 4.Northwest Portland Area Indian Health BoardPortlandUSA
  5. 5.Seattle Cancer Care AllianceSeattleUSA
  6. 6.School of MedicineUniversity of WashingtonSeattleUSA

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